Do psychiatrists have less access to medical services for their patients?

Continuity of care is a critical component of proper patient management. This is a particular concern for psychiatric patients who may require a diverse array of medical treatments over an extended period of time. Despite the importance of maintaining continuity of care among psychiatric patients, there is little evidence quantifying whether and how such continuity may be lacking. Yet such evidence is critical for assessing the extent of the problem and for determining the dimensions along which continuity may be deficient.

This paper examines continuity of care by comparing psychiatrists' perceptions of a variety of access measures to those of other physician specialists. A second aim of the study is to identify factors that may be responsible for any observed deficiencies in continuity of care among psychiatric patients.

We use physician survey data from the 2000/2001 Community Tracking Study (CTS) from the Center for Studying Health System Change and data from the Bureau of Health Professions' Area Resource File. We estimated multivariable models to help isolate the impact of different medical specialists' perceived ability to obtain specific types of medical care deemed medically necessary for their patients. In addition to medical specialty, the models controlled for patient, practice, and market characteristics.

Psychiatrists report dramatically lower levels of access to referrals, hospital admissions, ancillary care, adequate inpatient days, and imaging studies. Psychiatrists enjoy greater access only to outpatient mental health services. Surprisingly, psychiatrists do not enjoy any advantage vis-a-vis other specialists in their ability to obtain inpatient mental health services for their patients. Inadequate insurance among their patients, administrative barriers associated with health plans, and lack of availability of providers each appear to play a role in the difficulty psychiatrists experience gaining continuity of care for their patients.

Continuity of care is a multi-dimensional concept, including such domains as the quality of interpersonal interactions, information, care coordination, and access. Study limitations are that we focus on the access dimension of continuity of care and assess that dimension from the perspective of the physician. In addition, given the nature of our data, we have limited information on patient characteristics.

Relative to other specialists, psychiatrists perceive substantially less access for their patients to a variety of treatments. Barriers stemming from inadequate health insurance and lack of providers play an important role in shaping these perceptions.

Better management of mental health patients will require continuity of care that is more on a par with patients who are treated for non-mental health conditions. To achieve this objective, it appears that psychiatrists and their patients must be more fully integrated into the general medical care delivery system. It seems unlikely that such integration can occur without reducing the administrative and insurance barriers documented in this study that appear responsible for at least some of the barriers to continuity of care perceived by psychiatrists.

A useful direction for further research is to more thoroughly delineate patient characteristics associated with reduced continuity of care. In particular, it would be interesting to identify sociodemographic, socioeconomic, and other patient factors associated with the large deficits in continuity of care perceived by psychiatrists.